Association of Burnout With Emotional Intelligence and Personality in Surgical Residents: Can We Predict Who Is Most at Risk?

Publication date: Available online 1 December 2017
Source:Journal of Surgical Education
Author(s): Brenessa Lindeman, Emil Petrusa, Sophia McKinley, Daniel A. Hashimoto, Denise Gee, Douglas S. Smink, John T. Mullen, Roy Phitayakorn
ObjectivesBurnout is common among surgical residents and may be related to personality characteristics, emotional intelligence (EI), or work experiences.DesignLongitudinal cohort study over 1 year.SettingTertiary academic medical centers in the Northeast.ParticipantsAll general surgery residents in 2 programs (n = 143) were invited to complete an electronic survey at 3 time points; 88, 64, and 69 residents completed the survey (overall response rate 52%).ResultsSevere burnout was observed in 51% of residents (n = 41). Higher scores were associated with female sex (p = 0.02). Burnout scores were highest at the beginning and end of the academic year; EI and personality scores remained stable. On bivariate analysis, high EI score (p < 0.001), agreeableness and emotional stability personality features (p = 0.003), and positive job experiences (p < 0.01) were protective against burnout. Higher EI and positive work experiences were independent predictors of lower burnout (p < 0.01) after multivariable adjustment.ConclusionsSurgical residents have high levels of burnout. Higher EI and positive work experiences are associated with lower burnout. Focused interventions to improve EI and optimize the work environment may prevent or lessen burnout.



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Numéro 10/2017. Questions

Publication date: Available online 20 November 2017
Source:Revue des Maladies Respiratoires





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Microangiopathie thrombotique tumorale pulmonaire

Publication date: Available online 17 November 2017
Source:Revue des Maladies Respiratoires
Author(s): M. Merad, A. Alibay, S. Ammari, S. Antoun, A. Bouguerba, S. Ayed, F. Vincent
Le syndrome de microangiopathie thrombotique tumorale pulmonaire est une entité clinicopathologique rare où des micro-emboles de cellules tumorales dans la microcirculation pulmonaire induisent une microangiopathie thrombotique, une insuffisance respiratoire et un tableau de cœur pulmonaire aigus ou subaigus. Ses caractéristiques histologiques comprennent des micro-emboles tumoraux dans les petites artères et artérioles du poumon, associés à une prolifération fibrocellulaire et fibromusculaire de l'intima et parfois à la formation de thrombus. Le diagnostic est extrêmement difficile avant le décès. Ainsi, un grand nombre des observations rapportées reposent sur des données autopsiques. De très rares observations de diagnostics réalisés avant le décès suggèrent l'éventuelle efficacité d'une chimiothérapie. De nombreux détails restent à élucider, la recherche interdisciplinaire étant une priorité avec une étroite collaboration entre pathologistes et cliniciens afin de mieux comprendre ce syndrome le plus souvent mortel. Grâce à cette collaboration, il est éventuellement possible que ce syndrome ne soit plus considéré comme toujours ultimement fatal, l'utilisation de thérapeutiques ciblées permettant des survies de plusieurs mois après le diagnostic.Pulmonary tumor thrombotic microangiopathy syndrome is a rare clinicopathological entity in which tumor cell micro-emboli in the pulmonary microcirculation induced thrombotic microangiopathy. This can cause respiratory failure, and acute or sub-acute right heart failure. Histological features include micro tumor emboli in the small arteries and arterioles of the lung associated with thrombus formation and fibro-cellular and fibro-muscular intimal proliferation. The diagnosis is however extremely difficult to make before death. Thus, most of the observations reported are based on autopsy data. Very rare diagnostic observations made before death suggest the potential effectiveness of chemotherapy. Many details remain to be elucidated, interdisciplinary research is a priority with close collaboration between pathologists and clinicians to better understand this, often fatal, syndrome. It may be that the use of targeted therapies will improve the very poor prognosis allowing survival of several weeks or months after diagnosis.



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Éditorial : série moisissures intérieures

Publication date: Available online 16 November 2017
Source:Revue des Maladies Respiratoires
Author(s): D. Caillaud, D. Charpin




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Numéro 10/2017. Réponses

Publication date: Available online 21 November 2017
Source:Revue des Maladies Respiratoires





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Editorial board

Publication date: November 2017
Source:Revue des Maladies Respiratoires, Volume 34, Issue 9





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Evidence of the efficacy and safety of house dust mite subcutaneous immunotherapy in elderly allergic rhinitis patients: a randomized, double-blind placebo-controlled trial

Allergen specific immunotherapy (AIT) in elderly patients is controversial, and there is still little evidence supporting the safety and efficacy of this treatment in this population. The study objective was t...

http://ift.tt/2nhyy5P

Correction to: Adaptation in toxic environments: comparative genomics of loci carrying antibiotic resistance genes derived from acid mine drainage waters

Abstract

The original version of this article unfortunately contains a mistake.

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Report on the 2nd European Tissue Repair Society summer school, Brussels, Sept 11–12th, 2017

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Editorial Board

Publication date: December 2017
Source:Dental Materials, Volume 33, Issue 12





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Bone Marrow Myeloid Cells Regulate Myeloid-Biased Hematopoietic Stem Cells via a Histamine-Dependent Feedback Loop

Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Xiaowei Chen, Huan Deng, Michael J. Churchill, Larry L. Luchsinger, Xing Du, Timothy H. Chu, Richard A. Friedman, Moritz Middelhoff, Hongxu Ding, Yagnesh H. Tailor, Alexander L.E. Wang, Haibo Liu, Zhengchuan Niu, Hongshan Wang, Zhenyu Jiang, Simon Renders, Siu-Hong Ho, Spandan V. Shah, Pavel Tishchenko, Wenju Chang, Theresa C. Swayne, Laura Munteanu, Andrea Califano, Ryota Takahashi, Karan K. Nagar, Bernhard W. Renz, Daniel L. Worthley, C. Benedikt Westphalen, Yoku Hayakawa, Samuel Asfaha, Florence Borot, Chyuan-Sheng Lin, Hans-Willem Snoeck, Siddhartha Mukherjee, Timothy C. Wang
Myeloid-biased hematopoietic stem cells (MB-HSCs) play critical roles in recovery from injury, but little is known about how they are regulated within the bone marrow niche. Here we describe an auto-/paracrine physiologic circuit that controls quiescence of MB-HSCs and hematopoietic progenitors marked by histidine decarboxylase (Hdc). Committed Hdc⁺ myeloid cells lie in close anatomical proximity to MB-HSCs and produce histamine, which activates the H2 receptor on MB-HSCs to promote their quiescence and self-renewal. Depleting histamine-producing cells enforces cell cycle entry, induces loss of serial transplant capacity, and sensitizes animals to chemotherapeutic injury. Increasing demand for myeloid cells via lipopolysaccharide (LPS) treatment specifically recruits MB-HSCs and progenitors into the cell cycle; cycling MB-HSCs fail to revert into quiescence in the absence of histamine feedback, leading to their depletion, while an H2 agonist protects MB-HSCs from depletion after sepsis. Thus, histamine couples lineage-specific physiological demands to intrinsically primed MB-HSCs to enforce homeostasis.

Graphical abstract

Teaser

Chen et al. show that histidine decarboxylase (Hdc) marks quiescent myeloid-biased HSCs (MB-HSCs). Daughter myeloid cells form a spatial cluster with Hdc⁺ MB-HSCs and secrete histamine to enforce their quiescence and protect them from depletion, following activation by a variety of physiologic insults.


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Hypoxic Induction of Vasorin Regulates Notch1 Turnover to Maintain Glioma Stem-like Cells

Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Jianghong Man, Xingjiang Yu, Haidong Huang, Wenchao Zhou, Chaomei Xiang, Haohao Huang, Lucio Miele, Zhenggang Liu, Gurkan Bebek, Shideng Bao, Jennifer S. Yu
Tumor hypoxia is associated with poor patient survival and is a characteristic of glioblastoma. Notch signaling is implicated in maintaining glioma stem-like cells (GSCs) within the hypoxic niche, although the molecular mechanisms linking hypoxia to Notch activation have not been clearly delineated. Here we show that Vasorin is a critical link between hypoxia and Notch signaling in GSCs. Vasorin is preferentially induced in GSCs by a HIF1α/STAT3 co-activator complex and stabilizes Notch1 protein at the cell membrane. This interaction prevents Numb from binding Notch1, rescuing it from Numb-mediated lysosomal degradation. Thus, Vasorin acts as a switch to augment Notch signaling under hypoxic conditions. Vasorin promotes tumor growth and reduces survival in mouse models of glioblastoma, and its expression correlates with increased aggression of human gliomas. These findings provide mechanistic insights into how hypoxia promotes Notch signaling in glioma and identify Vasorin as a potential therapeutic target.

Graphical abstract

Teaser

Man et al. show that hypoxia preferentially augments Notch signaling in glioma stem-like cells by inducing the HIF1/STAT3 target gene Vasorin. Vasorin functions as a competitive inhibitor of Numb to reduce Notch turnover, augmenting Notch signaling under hypoxic stress.


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Dye-Independent Methods Reveal Elevated Mitochondrial Mass in Hematopoietic Stem Cells

Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Mariana Justino de Almeida, Larry L. Luchsinger, David J. Corrigan, Linda J. Williams, Hans-Willem Snoeck
Hematopoietic stem cells (HSCs) produce most cellular energy through glycolysis rather than through mitochondrial respiration. Consistent with this notion, mitochondrial mass has been reported to be low in HSCs. However, we found that staining with MitoTracker Green, a commonly used dye to measure mitochondrial content, leads to artefactually low fluorescence specifically in HSCs because of dye efflux. Using mtDNA quantification, enumeration of mitochondrial nucleoids, and fluorescence intensity of a genetically encoded mitochondrial reporter, we unequivocally show here that HSCs and multipotential progenitors (MPPs) have higher mitochondrial mass than lineage-committed progenitors and mature cells. Despite similar mitochondrial mass, respiratory capacity of MPPs exceeds that of HSCs. Furthermore, although elevated mitophagy has been invoked to explain low mitochondrial mass in HSCs, we observed that mitochondrial turnover capacity is comparatively low in HSCs. We propose that the role of mitochondria in HSC biology may have to be revisited in light of these findings.

Graphical abstract

Teaser

Snoeck and colleagues show that efflux of a mitochondrial content-reporting dye leads to the erroneous conclusion that HSCs have low mitochondrial content. Using alternative methodologies, they show that HSCs exhibit high mitochondrial content yet possess limited respiratory and turnover capacity. Mitochondria likely perform an essential yet unknown function in HSCs.


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Advancing our understanding of the neurobiology of anorexia nervosa: translation into treatment

Abstract

A wealth of studies has investigated the neurobiological underpinnings of anorexia nervosa. In our letter to the editor, we point to a number of ways in which the advances in our understanding of the neurobiology of anorexia nervosa - focusing on neuroimaging studies of brain structure and function - can be translated into treatment. We point to how such advances can: inform psychological treatment, be implemented in psychoeducation, point to novel therapeutic targets, lead to the identification of biomarkers, and expand our vocabulary for how we think and talk about anorexia nervosa.

http://ift.tt/2nknd4X

Comparative Efficacy of Daratumumab Monotherapy and Pomalidomide Plus Low‐Dose Dexamethasone in the Treatment of Multiple Myeloma: A Matching Adjusted Indirect Comparison

AbstractBackground.Daratumumab (a human CD38‐directed monoclonal antibody) and pomalidomide (an immunomodulatory drug) plus dexamethasone are both relatively new treatment options for patients with heavily pretreated multiple myeloma. A matching adjusted indirect comparison (MAIC) was used to compare absolute treatment effects of daratumumab versus pomalidomide + low‐dose dexamethasone (LoDex; 40 mg) on overall survival (OS), while adjusting for differences between the trial populations.Materials and Methods.The MAIC method reduces the risk of bias associated with naïve indirect comparisons. Data from 148 patients receiving daratumumab (16 mg/kg), pooled from the GEN501 and SIRIUS studies, were compared separately with data from patients receiving pomalidomide + LoDex in the MM‐003 and STRATUS studies.Results.The MAIC‐adjusted hazard ratio (HR) for OS of daratumumab versus pomalidomide + LoDex was 0.56 (95% confidence interval [CI], 0.38–0.83; p = .0041) for MM‐003 and 0.51 (95% CI, 0.37–0.69; p < .0001) for STRATUS. The treatment benefit was even more pronounced when the daratumumab population was restricted to pomalidomide‐naïve patients (MM‐003: HR, 0.33; 95% CI, 0.17–0.66; p = .0017; STRATUS: HR, 0.41; 95% CI, 0.21–0.79; p = .0082). An additional analysis indicated a consistent trend of the OS benefit across subgroups based on M‐protein level reduction (≥50%, ≥25%, and <25%).Conclusion.The MAIC results suggest that daratumumab improves OS compared with pomalidomide + LoDex in patients with heavily pretreated multiple myeloma.Implications for Practice.This matching adjusted indirect comparison of clinical trial data from four studies analyzes the survival outcomes of patients with heavily pretreated, relapsed/refractory multiple myeloma who received either daratumumab monotherapy or pomalidomide plus low‐dose dexamethasone. Using this method, daratumumab conferred a significant overall survival benefit compared with pomalidomide plus low‐dose dexamethasone. In the absence of head‐to‐head trials, these indirect comparisons provide useful insights to clinicians and reimbursement authorities around the relative efficacy of treatments.

http://ift.tt/2j46ka6

High‐Dose Mitotane‐Induced Encephalopathy in the Treatment of Adrenocortical Carcinoma

http://ift.tt/2BpJCQw

Pre‐ and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey

AbstractBackground.The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre‐ and postoperative chemotherapy is unclear and debated among experts.Materials and Methods.Medical oncology experts of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group were asked to participate in this survey on the use of pre‐ and postoperative chemotherapy in STS. Experts from 12 centers in Belgium, France, Germany, Great Britain, Italy, Switzerland, and The Netherlands agreed to participate and provided their treatment algorithm. Answers were converted into decision trees based on the objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies.Results.Several criteria used for decision‐making in extremity STS were identified: chemosensitivity, fitness, grading, location, and size. In addition, resectability and resection status were relevant in the pre‐ and postoperative setting, respectively. Preoperative chemotherapy is considered in most centers for marginally resectable tumors only. Yet, in some centers, neoadjuvant chemotherapy is used routinely and partially combined with hyperthermia. Although most centers do not recommend postoperative chemotherapy, some offer this treatment on a regular basis. Radiotherapy is an undisputed treatment modality in extremity STS.Conclusion.Due to lacking evidence on the utility of pre‐ and postoperative chemotherapy in localized extremity STS, treatment strategies vary considerably among European experts. The majority recommended neoadjuvant chemotherapy for marginally resectable grade 2–3 tumors; the majority did not recommend postoperative chemotherapy in any setting.Implications for Practice.The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre‐ and postoperative chemotherapy is unclear and debated among experts. This study analyzed the decision‐making process among 12 European experts on systemic therapy for STS. A wide range of recommendations among experts regarding the use of perioperative chemotherapy was discovered. Discrepancies in the use of decision criteria were also uncovered, including the definition of what constitutes high‐risk cancer, which is a basis for many to recommend chemotherapy. Before any standardization is possible, a common use of decision criteria is necessary.

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Immunotherapy for Head and Neck Cancer in the Era of Exponentially Increasing Health Care Expenditure

http://ift.tt/2BqrPc3

The European Medicines Agency Review of Panobinostat (Farydak) for the Treatment of Adult Patients with Relapsed and/or Refractory Multiple Myeloma

AbstractOn August 28, 2015, a marketing authorization valid through the European Union was issued for panobinostat, in combination with bortezomib and dexamethasone, for the treatment of adult patients with relapsed and/or refractory multiple myeloma who have received at least two prior regimens including bortezomib and an immunomodulatory agent (IMiD).Panobinostat is an orally available histone deacetylase (HDAC) inhibitor that inhibits the enzymatic activity of HDAC proteins at nanomolar concentrations. HDAC proteins catalyze the removal of acetyl groups from the lysine residues of histones and some nonhistone proteins. Inhibition of HDAC activity results in increased acetylation of histone proteins, an epigenetic alteration that results in a relaxing of chromatin, leading to transcriptional activation. The recommended starting dose of panobinostat is 20 mg, taken orally in a cyclical manner for up to 48 weeks.The use of panobinostat in combination with bortezomib and dexamethasone was studied in a randomized, double‐blind, placebo‐controlled, multicenter phase III study (PANORAMA I) in 768 patients with relapsed or relapsed and refractory multiple myeloma who had received one to three prior lines of therapies. In the subgroup of patients who have received at least two prior regimens including bortezomib and an IMiD, there was a difference of 7.8 months in the progression‐free survival in favor of the experimental arm (12.5 months for panobinostat + bortezomib + dexamethasone vs. 4.7 months for placebo + bortezomib + dexamethasone; hazard ratio = 0.47, 95% confidence interal 0.31–0.72; log‐rank p value = .0003). The incidence of grade 3–4 adverse events suspected to be related to study drug was 76.9% vs. 51.2%, for the panobinostat and the placebo group, respectively. The most common side effects (grade 3–4) associated with panobinostat included diarrhea (18.9%), fatigue (14.7%), nausea (4.5%), vomiting (5.5%), thrombocytopenia (43.6%), anemia (7.9%), neutropenia (16.5%) and lymphopenia (8.1%).This article summarizes the scientific review of the application leading to regulatory approval in the European Union. The full scientific assessment report and product information, including the Summary of Product Characteristics, are available on the European Medicines Agency website (http://ift.tt/28Lv8Np).Implications for Practice.Farydak was approved in the European Union in combination with bortezomib and dexamethasone, for the treatment of adult patients with relapsed and/or refractory multiple myeloma who have received at least two prior regimens including bortezomib and an immunomodulatory agent (IMiD). The addition of panobinostat to bortezomib and dexamethasone resulted in a clinically meaningful and statistically significant improvement of progression‐free survival compared with bortezomib and dexamethasone, and an additional therapeutic option with a new mechanism of action was considered valuable. Although the toxicity associated with panobinostat combination was significant, at the time of the marketing authorization of panobinostat, it was considered that it was acceptable and that it should be left to the clinician and the patient to decide whether the panobinostat combination is the preferred treatment option or not.

http://ift.tt/2j4DK8A

Congratulations Shannon O’Donnell, Diane Guerrero, Irina Potapova, and Shannon Doolittle, Student Success Fee Funding Recipients!

SLHS wants to congratulate the following recipients of the 2017-2018 Student Success Fee Academic Related Program.  This program provides students an opportunity to become engaged and involved in their education outside their academic courses.  Successful student proposals focus on academic enhancement, high impact practices, colloquia etc.

Undergraduate:

Shannon O'Donnell (Faculty Sponsor: Peter Torre):  Excellence in SLHS Student Research

The goal for this proposed project is directly in line with the San Diego State University mission to have students, at all levels, be involved in research. This proposal is requesting travel support for students to independently present at a national conference.

MA Program:

Diane Guerrero (Faculty Sponsor: Sonja Pruitt-Lord):  Speech Language Pathology CSHA Convention

Funds are requested to support 20 undergraduate, graduate and doctoral students in attending the 2018 CSHA Convention being held in Sacramento, CA, March 22-25, 2018. Funds will be used to pay for student registration, airfare, and hotel costs.

SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders:

Irina Potapova (Faculty Sponsor: Sonja Pruitt-Lord):  Fourth Annual Speech, Language and Hearing Awareness and Information Day (SAID)

Professional development events for students in Speech, Language and Hearing Sciences and peers in related fields (e.g., Education, Public Health, Physical Therapy). The project includes a professional mentoring event and our fourth annual Speech, Language and Hearing Awareness and Information Day.

SDSU/UCSD Joint Doctoral Program in Audiology:

Shannon Doolittle (Faculty Sponsor: Laura Dreisbach-Hawe):  Speech, Language, and Hearing Sciences Guest Speaker Event

Since 2003, the Student Academy of Audiology has invited internationally-recognized speakers to present their leading research to students of all levels, faculty, and professional members of the community through the generous support of IRA funds provided by the College of Health and Human Sciences.

 

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Clinical Thyroidology High-Impact Articles

FREE ACCESS through December 14, 2017.
Read Now:

Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration
Stephanie A. Fish 

Are Wider TSH Cutoffs for Reflex Testing of Free T4 Feasible, Safe and Cost-Effective?
Jacques Orgiazzi 

Punctate Echogenic Foci on Thyroid Ultrasound Do Not Necessarily Represent Calcifications on Histopathology
Martin Biermann 

Significant Variations of Thyroid Testing in the U.S. Argue for Improved Standardization of Practice Patterns
Angela M. Leung 

The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.

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via IFTTT

Clinical Thyroidology High-Impact Articles

FREE ACCESS through December 14, 2017.
Read Now:

Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration
Stephanie A. Fish 

Are Wider TSH Cutoffs for Reflex Testing of Free T4 Feasible, Safe and Cost-Effective?
Jacques Orgiazzi 

Punctate Echogenic Foci on Thyroid Ultrasound Do Not Necessarily Represent Calcifications on Histopathology
Martin Biermann 

Significant Variations of Thyroid Testing in the U.S. Argue for Improved Standardization of Practice Patterns
Angela M. Leung 

The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.

http://ift.tt/2iuNGv4

Transformation of sulfaquinoxaline by chlorine and UV light in water: kinetics and by-product identification

Abstract

Sulfaquinoxaline (SQX) is an antimicrobial of the sulfonamide class, frequently detected at low levels in drinking and surface water as organic micropollutant. The main goal of the present study is the evaluation of SQX reactivity during chlorination and UV irradiations which are two processes mainly used in water treatment plants. The SQX transformation by chlorination and UV lights (254 nm) was investigated in purified water at common conditions used for water disinfection (pH = 7.2, temperature = 25 °C, [chlorine] = 3 mg L⁻¹). The result shows a slow degradation of SQX during photolysis compared with chlorination process. Kinetic studies that fitted a fluence-based first-order kinetic model were used to determine the kinetic constants of SQX degradation; they were equal to 0.7 × 10⁻⁴ and 0.7 × 10⁻² s⁻¹corresponding to the half time lives of 162 and 1.64 min during photolysis and chlorination, respectively. In the second step, seven by-products were generated during a chlorination and photo-transformation of SQX and identified using liquid chromatography with electrospray ionization and tandem mass spectrometry (MS-MS). SO₂ extrusion and direct decomposition were the common degradation pathway during photolysis and chlorination. Hydroxylation and isomerization were observed during photodegradation only while electrophilic substitution was observed during chlorination process.

http://ift.tt/2i5H2aS

Comparative studies on the performance and emissions of a direct injection diesel engine fueled with neem oil and pumpkin seed oil biodiesel with and without fuel preheater

Abstract

In the present experimental analysis, two non-edible oils namely neem oil and pumpkin seed oil were considered. They are converted into respective biodiesels namely neem oil methyl ester (B1) and pumpkin seed oil methyl ester (B2) through transesterification process and their physical and chemical properties were examined using ASTM standards. Diesel was used as a baseline fuel in Kirloskar TV1 model direct injection four stroke diesel engine. A fuel preheater was designed and fabricated to operate at various temperatures (60, 70, and 80 °C). Diesel showed higher brake thermal efficiency (BTE) than biodiesel samples. Lower brake specific fuel consumption (BSFC) was obtained with diesel than B1 sample. B1 exhibited lower BSFC than B2 sample without preheating process. High preheating temperature (80 °C) results in lower fuel consumption for B1 sample. The engine emission characteristics like carbon monoxide (CO), hydrocarbon (HC), and smoke were found lower with B1 sample than diesel and B2 except oxides of nitrogen (NOx) emission. In preheating of fuel, B1 sample with high preheating temperature showed lower CO, HC, and smoke emission (except NOx) than B2 sample.

http://ift.tt/2jBxchk

Effects of lead, cadmium, chromium, and arsenic on the sorption of lindane and norfloxacin by river biofilms, particles, and sediments

Abstract

The sorption of both classic and emerging organic contaminants onto aquatic solids is a critical process that controls their fate in natural waters. Sorption is affected by numerous factors, including coexisting heavy metals. The mechanisms of the influence of heavy metals, especially those occurring in acid radical anions, are still unclear. Here, the effects of Pb, Cd, Cr, and As on the sorption of lindane and norfloxacin (NOR) onto natural biofilms, suspended particles, and sediments from one river were investigated following batch equilibration methods. In addition, changes in representative components that have important roles in sorption from these solids in the presence and absence of metals were characterized by spectrum analyses. The results indicated that sorption of lindane and NOR on the three solids in the absence of heavy metals was highly linear and nonlinear, respectively. Pb and Cd promoted and Cr and As suppressed hydrophobic lindane sorption on the three solids. This was because Pb and Cd enhanced but Cr and As weakened the hydrophobicity of these solids. Pb, Cd, Cr, and As decreased NOR sorption on sediments and suspended particles at pH 5.7~6.3. This was due to electrostatic competition between cationic Pb/Cd and NORH₂⁺, and the combination of Cr/As acid radicals with NORH₂⁺, which suppressed its ion-exchange adsorption. Pb, Cd, Cr, and As generally increased the sorption of NOR onto the biofilms at pH 5.7~6.3. Pb and Cd strengthened the flocculation of dissolved organic matter combined with NORH₂⁺ onto the biofilms. Cr and As enhanced the hydrophilicity of biofilms, and then increased their sorption of NOR with active hydrophilic groups. The mechanisms of how different heavy metals affect NOR sorption by biofilms were more complicated than the mechanisms affecting lindane sorption, as well as by sediments and particles.

http://ift.tt/2AlAcWJ

In reference to “Central nervous system anomalies in craniofacial microsomia: a systematic review”

We read with interest the in-depth review by Renkema and colleagues on central nervous system (CNS) involvement in patients affected by craniofacial microsomia1. In this article, the authors clearly showed that CNS abnormalities are commonly detected (2–69%), thus confirming that malformations in craniofacial microsomia go far beyond isolated skeletal abnormalities. The authors also underlined the need to investigate further the true prevalence rate of CNS involvement through the performance of dedicated studies, and attributed the wide range of CNS abnormality detection rates to selection bias, as patients with neurological symptoms are more likely to undergo neuroimaging studies.

http://ift.tt/2AwvI2p

Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial

The aim of this study was to evaluate the clinical efficacy of 4% articaine (Ar4) compared to 2% mepivacaine (Me2), both in combination with 1:100,000 epinephrine, in a unique soft tissue model. This was a randomized, double-blind, crossover clinical trial. The anaesthetic was applied to the lower lip using a computerized local delivery system. The following were evaluated: blood flow, thermal sensation, pressure and proprioception, extent of anaesthesia, gradual elimination, and the final duration of the effect of the anaesthesia.

http://ift.tt/2iuME1X

Earwax MD Now Available in Canada

Eosera (https://earcaremd.com/) has made Earwax MD available in Canada through Amazon.ca, the first foreign market the company has brought its product to. On Amazon.ca, the product is available in a kit that includes a 15 mL bottle and rinsing bulb. Amazon Prime members can get Earwax MD with free shipping on Amazon.ca. The topical cerumen-dissolving drop has been stocked in CVS stores across the United States since August, and has been part of the U.S. Amazon Exclusives program since April 2017.

Elyse Dickerson, co-founder and CEO of Eosera, said they founded Eosera to develop solutions for unmet healthcare needs that would have a global impact, and since launching Earwax MD on Amazon.com in April, they have received considerable interest from Canadian consumers, audiologists, ENTs and other health care professionals. "We are thrilled to enter Canada on Amazon.ca, so that from the start, we are available to all Canadians," Dickerson said. "We are working towards a larger distribution channel in Canada, and anticipate availability in retail stores and additional distributors in the future."

Published: 11/30/2017 3:52:00 PM

http://ift.tt/2AmZTpU

Intense phototoxic reactions to photodynamic therapy in immunosuppressed renal transplant patients

Publication date: March 2018
Source:Photodiagnosis and Photodynamic Therapy, Volume 21
Author(s): V.K. Ortner, M. Haedersdal, H.C. Wulf, K. Togsverd-Bo




http://ift.tt/2iuCKNN

Pregnancy and Lifetime Exposure to Fine Particulate Matter and Infant Mortality in Massachusetts, 2001–2007

Abstract

Many studies have found associations between particulate matter having an aerodynamic diameter of ≤2.5 μm (PM_2.5) and adult mortality. Comparatively few studies evaluated particles and infant mortality, although infants and children are particularly vulnerable to pollution. Moreover, existing studies mostly focused on short-term exposure to larger particles. We investigated PM_2.5 exposure during pregnancy and lifetime and postneonatal infant mortality. The study included 465,682 births with 385 deaths in Massachusetts (2001–2007). Exposures were estimated from PM_2.5-prediction models based on satellite imagery. We applied extended Cox proportional hazards modeling with time-dependent covariates to total, respiratory, and sudden infant death syndrome mortality. Exposure was calculated from birth to death (or end of eligibility for outcome, at age 1 year) and pregnancy (gestation and each trimester). Models adjusted for sex, birth weight, gestational length, season of birth, temperature, relative humidity, and maternal characteristics. Hazard ratios for total, respiratory, and sudden infant death syndrome mortality per-interquartile-range increase (1.3 μg/m³) in lifetime PM_2.5 exposure were 2.66 (95% confidence interval (CI): 2.11, 3.36), 3.14 (95% CI: 2.39, 4.13), and 2.50 (95% CI: 1.56, 4.00), respectively. We did not observe a statistically significant relationship between gestational exposure and mortality. Our findings provide supportive evidence that lifetime exposure to PM_2.5 increases risk of infant mortality.

http://ift.tt/2BpqC4z

RE: “TIME SPENT COMMUTING TO WORK AND MENTAL HEALTH: EVIDENCE FROM 13 WAVES OF AN AUSTRALIAN COHORT STUDY”

http://ift.tt/2j6M87x

THE AUTHORS REPLY

http://ift.tt/2Bpq7rd

Infections in Early Life and Development of Celiac Disease

Abstract

It has been suggested that early infections are associated with increased risk for later celiac disease (CD). We analyzed prospective claims data of infants from Bavaria, Germany, born between 2005 and 2007 (n = 295,420), containing information on medically attended infectious diseases according to International Classification of Diseases, Tenth Revision, codes in quarterly intervals. We calculated hazard ratios and 95% confidence intervals for time to CD diagnosis by infection exposure, adjusting for sex, calendar month of birth, and number of previous healthcare visits. CD risk was higher among children who had had a gastrointestinal infection during the first year of life (hazard ratio = 1.32, 95% confidence interval: 1.12, 1.55) and, to a lesser extent, among children who had had a respiratory infection during the first year of life (hazard ratio = 1.22, 95% confidence interval: 1.04, 1.43). Repeated gastrointestinal infections during the first year of life were associated with particularly increased risk of CD in later life. These findings indicate that early gastrointestinal infections may be relevant for CD development.

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Maternal Lifetime Stress and Prenatal Psychological Functioning and Decreased Placental Mitochondrial DNA Copy Number in the PRISM Study

Abstract

Psychosocial stress contributes to placental oxidative stress. Mitochondria are vulnerable to oxidative stress, which can lead to changes in mitochondrial DNA copy number (mtDNAcn). We examined associations of maternal lifetime stress, current negative life events, and depressive and posttraumatic-stress-disorder symptom scores with placental mtDNAcn in a racially/ethnically diverse sample (n = 147) from the Programming of Intergenerational Stress Mechanisms (PRISM) study (Massachusetts, March 2011 to August 2012). In linear regression analyses adjusted for maternal age, race/ethnicity, education, prenatal fine particulate matter exposure, prenatal smoking exposure, and the sex of the child, all measures of stress were associated with decreased placental mtDNAcn (all P values < 0.05). Weighted-quantile-sum (WQS) regression showed that higher lifetime stress and depressive symptoms accounted for most of the effect on mtDNAcn (WQS weights: 0.25 and 0.39, respectively). However, among white individuals, increased lifetime stress and posttraumatic stress disorder symptoms explained the majority of the effect (WQS weights: 0.20 and 0.62, respectively) while among nonwhite individuals, lifetime stress and depressive symptoms accounted for most of the effect (WQS weights: 0.27 and 0.55, respectively). These analyses are first to link increased maternal psychosocial stress with reduced placental mtDNAcn and add to literature documenting racial/ethnic differences in the psychological sequelae of chronic stress that may contribute to maternal-fetal health.

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Measuring the Impact of Disasters Using Publicly Available Data: Application to Hurricane Sandy (2012)

Abstract

The unexpected nature of disasters leaves little time or resources for organized health surveillance of the affected population, and even less for those who are unaffected. An ideal epidemiologic study would monitor both groups equally well, but would typically be decided against as infeasible or costly. Exposure and health outcome data at the level of the individual can be difficult to obtain. Despite these challenges, the health effects of a disaster can be approximated. Approaches include 1) the use of publicly available exposure data in geographic detail, 2) health outcomes data—collected before, during, and after the event, and 3) statistical modeling designed to compare the observed frequency of health outcomes with the counterfactual frequency hidden by the disaster itself. We applied these strategies to Hurricane Sandy, which struck the northeastern United States in October 2012. Hospital admissions data from the state of New York with information on primary payer as well as patient demographic characteristics were analyzed. To illustrate the method, we present multivariate logistic regression results for the first 2 months after the hurricane. Inferential implications of admissions data on nearly the entire target population in the wake of a disaster are discussed.

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Group-Based Trajectory of Body Shape From Ages 5 to 55 Years and Cardiometabolic Disease Risk in 2 US Cohorts

Abstract

The association of adiposity across the life span with cardiometabolic risk is not completely delineated. We used a group-based modeling approach to identify distinct trajectories of body shape from ages 5 years to 55 years among 84,792 women from the Nurses' Health Study (1976–2010) and 37,706 men from the Health Professionals Follow-up Study (1986–2010) and assessed the associations between these trajectories and incidence of type 2 diabetes and cardiovascular disease (CVD) during a 17-year follow-up period. Compared with those who maintained leanness throughout the life span ("lean-stable" trajectory), participants who maintained a medium body shape ("medium-stable" trajectory) had somewhat increased risk. Those who started lean but had a moderate or marked increase in adiposity ("lean-moderate increase" and "lean-marked increase" trajectories) had even higher risk (e.g., for a "lean-marked increase" trajectory, the hazard ratio for diabetes was 8.11 (95% confidence interval (95% CI): 7.10, 9.27) in women and 2.36 (95% CI: 2.04, 2.74) in men; for CVD, it was 1.38 (95% CI: 1.25, 1.52) in women and 1.28 (95% CI: 1.16, 1.41) in men). Participants who started heavy and became heavier (a "heavy-increase" trajectory) had substantially elevated risk (for diabetes, the hazard ratio was 7.34 (95% CI: 6.40, 8.42) in women and 2.80 (95% CI: 2.37, 3.31) in men; for CVD, it was 1.55 (95% CI: 1.40, 1.71) in women and 1.35 (95% CI: 1.20, 1.53) in men). Our data showed that trajectories of body shape from ages 5 to 55 years were associated with subsequent risk of developing type 2 diabetes and CVD.

http://ift.tt/2j6cMNK

Advanced Maternal Age and the Risk of Low Birth Weight and Preterm Delivery: a Within-Family Analysis Using Finnish Population Registers

Abstract

Advanced maternal age at birth is considered a major risk factor for birth outcomes. It is unclear to what extent this association is confounded by maternal characteristics. To test whether advanced maternal age at birth independently increases the risk of low birth weight (<2,500 g) and preterm birth (<37 weeks' gestation), we compared between-family models (children born to different mothers at different ages) with within-family models (children born to the same mother at different ages). The latter procedure reduces confounding by unobserved parental characteristics that are shared by siblings. We used Finnish population registers, including 124,098 children born during 1987–2000. When compared with maternal ages 25–29 years in between-family models, maternal ages of 35–39 years and ≥40 years were associated with percentage increases of 1.1 points (95% confidence intervals: 0.8, 1.4) and 2.2 points (95% confidence intervals: 1.4, 2.9), respectively, in the probability of low birth weight. The associations are similar for the risk of preterm delivery. In within-family models, the relationship between advanced maternal age and low birth weight or preterm birth is statistically and substantively negligible. In Finland, advanced maternal age is not independently associated with the risk of low birth weight or preterm delivery among mothers who have had at least 2 live births.

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Neighborhood Physical Environment and Changes in Body Mass Index: Results From the Multi-Ethnic Study of Atherosclerosis

Abstract

Longitudinal associations between neighborhood characteristics and body mass index (BMI; weight (kg)/height (m)²) were assessed from 2000 to 2011 among 5,919 participants in the Multi-Ethnic Study of Atherosclerosis. The perceived availability of healthy food and walking environment were assessed via surveys, and 1-mile (1.6-km) densities of supermarkets, fruit-and-vegetable stores, and recreational facilities were obtained through a commercial database. Econometric fixed-effects models were used to estimate the association between within-person changes in neighborhood characteristics and within-person change in BMI. In fully adjusted models, a 1-standard-deviation increase in the healthy food environment index was associated with a 0.16-kg/m² decrease in BMI (95% confidence interval (CI): −0.27, −0.06) among participants with obesity at baseline. A 1-standard-deviation increase in the physical activity environment index was associated with 0.13-kg/m² (95% CI: −0.24, −0.02) and 0.14-kg/m² (95% CI: −0.27, −0.01) decreases in BMI for participants who were overweight and obese at baseline, respectively. Paradoxically, increases in the physical activity index were associated with BMI increases in persons who were normal-weight at baseline. This study provides preliminary longitudinal evidence that favorable changes in neighborhood physical environments are related to BMI reductions in obese persons, who comprise a substantial proportion of the US population.

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Potential for Bias When Estimating Critical Windows for Air Pollution in Children’s Health

Abstract

Evidence supports an association between maternal exposure to air pollution during pregnancy and children's health outcomes. Recent interest has focused on identifying critical windows of vulnerability. An analysis based on a distributed lag model (DLM) can yield estimates of a critical window that are different from those from an analysis that regresses the outcome on each of the 3 trimester-average exposures (TAEs). Using a simulation study, we assessed bias in estimates of critical windows obtained using 3 regression approaches: 1) 3 separate models to estimate the association with each of the 3 TAEs; 2) a single model to jointly estimate the association between the outcome and all 3 TAEs; and 3) a DLM. We used weekly fine-particulate-matter exposure data for 238 births in a birth cohort in and around Boston, Massachusetts, and a simulated outcome and time-varying exposure effect. Estimates using separate models for each TAE were biased and identified incorrect windows. This bias arose from seasonal trends in particulate matter that induced correlation between TAEs. Including all TAEs in a single model reduced bias. DLM produced unbiased estimates and added flexibility to identify windows. Analysis of body mass index z score and fat mass in the same cohort highlighted inconsistent estimates from the 3 methods.

http://ift.tt/2BoWS7P

Historical anthropogenic mercury in two lakes of Central Chile: comparison between an urban and rural lake

Abstract

Mercury concentrations in the environment tend to decrease in recent years due to environmental restrictions. Lakes store mercury in their sediments, making them potential secondary contamination sources. In South America, the occurrence of mercury in lake systems has been associated mainly with volcanic emissions and only few records anthropogenic contamination in the pre-Hispanic period. The objective of this research was to study historical anthropogenic mercury concentration in two lakes in Central Chile (La Señoraza and Pillo), in order to establish background mercury levels and their variations from preindustrial to modern periods. Different background levels and mercury concentrations were found in each lake, with significantly higher concentrations in Lake La Señoraza during the last 150 years. Mining-related activities during the nineteenth century could have a negligible influence on mercury concentrations. Later on, the use of coal railroads and subsequent employment of mercury in the cellulose industry were associated with three- and fourfold increases in mercury concentration over the nineteenth century background levels, which decrease once these activities ceased. However, in the case of Lake Pillo, an important increase in mercury concentration can be observed between 1990 and the early twenty-first century, which could be related to a higher watershed/lake area ratio, extensive agriculture, and volcanic emission, being the latter that could have contributed with mercury to both systems. Nevertheless, sedimentological characteristics in Lake Pillo can be favorable to retain mercury in this aquatic system up to the present day.

http://ift.tt/2AoIbCz

Spatio-temporal evaluation of emerging contaminants and their partitioning along a Brazilian watershed

Abstract

The occurrence, partitioning, and spatio-temporal distribution of seven pharmaceuticals for human use, three steroid hormones and one personal care product were determined in surface water, suspended particulate matter (SPM), and sediment of Piraí Creek and Jundiaí River (Jundiaí River Basin, São Paulo, Brazil). The maximum average detected concentrations of the compounds in the Piraí River samples were < 30 ng L⁻¹, except for caffeine (222 ng L⁻¹). In Jundiaí River samples, most of the compounds were frequently detected, wherein caffeine had the highest concentration, with maximum average concentrations of 14,050 ng L⁻¹, followed by atenolol (431 ng L⁻¹), ibuprofen (268 ng L⁻¹) and diclofenac (214 ng L⁻¹). Atenolol, propranolol, estrone, and triclosan were the contaminants most frequently detected in sediment and SPM samples. Triclosan had the highest average proportion of SPM as opposed to in the aqueous phase (> 75%). Contaminants with acid functional groups showed, in general, a lower tendency to bind to particulate matter and sediments. In addition, hydrophobicity had an important effect on their environmental partitioning. The spatial distribution of contaminants along the Jundiaí River was mainly affected by the higher concentration of contaminants in water samples collected downstream from a sewage treatment plant (STP). The results obtained here clearly showed the importance of the analysis of some contaminants in the whole water, meaning both dissolved and particulate compartments in the water, and that the partitioning is ruled by a set of parameters associated to the physicochemical characteristics of contaminants and the matrix properties of the studied, which need be considered in an integrated approach to understand the fate of emerging chemical contaminants in aquatic environments.

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Commentary to letter to the editor to manuscript “Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life”

We indeed appreciate the comments of Dr. Singh Bakshi and would like to take the opportunity to remark on them.

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Retrograde parotidectomy and facial nerve outcomes: A case series of 44 patients (Letter to Editor)

I read with interest about the nicely written article entitled "Retrograde Parotidectomy and Facial Nerve Outcomes: A case Series of 44 Patients" by Kligerman et al. [1]. I would like to congratulate the authors on their good results of retrograde parotidectomy. They demonstrated that the complications after retrograde parotidectomy, especially of facial nerve injury, are not inferior to the counterpart of antegrade parotidectomy. In addition, the former approach could achieve a low wound complication rate of 6.8% and facilitate outpatient surgery.

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2017 Highlights

Patient Success Stories Otorhinolaryngology And Neurosurgery Team Up To Maximize The Outcome For A Patient With Pituitary Tumor Virtual Presurgical... Read the full article...

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Warmer Weather as a Risk Factor for Cellulitis: A Population-based Investigation

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Jamal Taha




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Response to Letter to the Editor

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Jan Van Keer, Karel Van Keer, Joachim Van Calster, Inge Derdelinckx




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Blood Biomarkers for the Early Diagnosis of Stroke

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Heather Roesly




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Physician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Renaldo C. Blocker, Heather A. Heaton, Katherine L. Forsyth, Hunter J. Hawthorne, Nibras El-Sherif, M. Fernanda Bellolio, David M. Nestler, Thomas R. Hellmich, Kalyan S. Pasupathy, M. Susan Hallbeck
BackgroundIt is unclear how workflow interruptions impact emergency physicians at the point of care.ObjectivesOur study aimed to evaluate interruption characteristics experienced by academic emergency physicians.MethodsThis prospective, observational study collected interruptions during attending physician shifts. An interruption is defined as any break in performance of a human activity that briefly requires attention. One observer captured interruptions using a validated tablet PC-based tool that time stamped and categorized the data. Data collected included: 1) type, 2) priority of interruption to original task, and 3) physical location of the interruption. A Kruskal-Wallis H test compared interruption priority and duration. A chi-squared analysis examined the priority of interruptions in and outside of the patient rooms.ResultsA total of 2355 interruptions were identified across 210 clinical hours and 28 shifts (means = 84.1 interruptions per shift, standard deviation = 14.5; means = 11.21 interruptions per hour, standard deviation = 4.45). Physicians experienced face-to-face physician interruptions most frequently (26.0%), followed by face-to-face nurse communication (21.7%), and environment (20.8%). There was a statistically significant difference in interruption duration based on the interruption priority, χ²(2) = 643.98, p < 0.001, where durations increased as priority increased. Whereas medium/normal interruptions accounted for 53.6% of the total interruptions, 53% of the interruptions that occurred in the patient room (n = 162/308) were considered low priority (χ² [2, n = 2355] = 78.43, p < 0.001).ConclusionsOur study examined interruptions over entire provider shifts and identified patient rooms as high risk for low-priority interruptions. Targeting provider-centered interventions to patient rooms may aid in mitigating the impacts of interruptions on patient safety and enhancing clinical care.



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Editorial Board

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6





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Comparison of Lactic Acid Levels in Children with Suspected and Confirmed Intussusception

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Vanessa Tamas, Paul Ishimine
BackgroundCurrently, no laboratory test can identify children with intussusception. Lactic acid is a marker of ischemia in gastrointestinal emergencies.ObjectivesWe present a case series comparing lactic acid levels in children with suspected and confirmed intussusception.MethodsThis is a prospective single case series of 39 patients who had suspected intussusception. Patients were eligible if they underwent abdominal ultrasound screening for suspected intussusception. Blood collected at the time of peripheral intravenous line placement was analyzed for lactic acid levels before ultrasound.ResultsThirty-nine patients were enrolled; 16 were diagnosed with intussusception. Mean (± standard deviation) lactic acid levels were not significantly different between children with suspected (1.7 ± 0.69 mmol/L) and confirmed intussusception (1.93 ± 1.13 mmol/L).ConclusionsLactic acid levels cannot identify children with intussusception.



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Emergency Coagulation Assessment During Treatment with Direct Oral Anticoagulants

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Krysia Crabtree




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Rotational Thromboelastometry Significantly Optimizes Transfusion Practices for Damage Control Resuscitation in Combat Casualties

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Heather Roesly




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Patterns and Outcomes Associated with Timeliness of Initial Crystalloid Resuscitation in Prospective Sepsis and Septic Shock Cohort

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Forrest Andersen




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Unintentional Marijuana Exposure Presenting as Altered Mental Status in the Pediatric Emergency Department: A Case Series

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Anita A. Thomas, Suzan Mazor
BackgroundUnintentional tetrahydrocannabinol (THC) exposure in pediatric patients can present as altered mental status. Altered mental status in a pediatric patient often leads to invasive diagnostic testing.Case ReportThe following cases describe 3 pediatric patients in Washington state who presented to a tertiary care children's hospital emergency department (ED) with altered mental status, later found to have urine toxicology screening positive for inactive THC metabolite (positive THC toxicology screen). Case 1 is a 6-year-old boy who presented with vomiting, lethargy, and hallucinations. Case 2 is a 5-year-old girl who presented with nausea, slurred speech, ataxia, and lethargy in the setting of a minor head injury. Case 3 is a 7-month-old boy who presented with vomiting and lethargy in the setting of a minor fall the day prior to ED evaluation. All children had extensive work-ups before the diagnosis was made; 2 were discharged home and 1 was admitted to the pediatric intensive care unit.Why Should an Emergency Physician Be Aware of This?As access to marijuana increases with growing legalization, it is important to be familiar with state marijuana legislation, to consider and ask families about access to marijuana products as a potential contributor to altered mental status, and to be aware of potential caretaker reluctance regarding disclosure of marijuana use secondary to perceived stigma. Maintaining awareness of the clinical effects of THC exposure in children may limit invasive testing in a hemodynamically stable child with altered mental status.



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Klebsiella pneumoniae Invasive Liver Abscess Syndrome and Endophthalmitis

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Beuy Joob, Viroj Wiwanitkit




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Low Yield of Clinically Significant Injury With Head-To-Pelvis Computed Tomography in Blunt Trauma Evaluation

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Shelby P. Murphy, Noah Hawthorne, David Haase, Chika Chiku, Jason Wen, Robert M. Rodriguez
BackgroundMany trauma centers have adopted routine head-to-pelvis computed tomography (CT) imaging for the evaluation of adults with blunt trauma.ObjectiveWe sought to determine the yields of detecting clinically significant injuries (CSIs) with CT in >1 anatomic region.MethodsWe conducted this observational cohort study of all trauma activation patients >14 years of age who received CT imaging during blunt trauma evaluation at a Level 1 trauma center from April to October 2014. Expert panels determined the clinical significance of head, neck, chest, abdomen, and pelvis injuries seen on CT. We calculated yields of CSI, defined as the number of patients with CSI divided by the total number of patients who underwent CT imaging. The 3 specified anatomic regions considered were head/neck, chest, and abdomen/pelvis.ResultsThe median age of 1236 patients who had CT was 48 years; 69% were male; 51.2% were admitted; and hospital mortality was 4.4%. Yields of CSI with 95% confidence intervals (CIs) were: head/neck region injury 11.3% (9.6–13.3%); chest region injury only 7.9% (6.0–10.4%); abdomen/pelvis region injury only 5.1% (3.7–7.0%); both head/neck and chest CSI 2.8% (1.7–4.5%); both head/neck and abdomen/pelvis CSI 1.6% (0.9–2.9%); and both chest and abdomen/pelvis CSI 1.1% (0.5–2.4%). The yield of CSI in all 3 anatomic regions with head-to-pelvis CT was 0.6% (0.2–1.7%), and 76.7% (68.8–83.1%) of CSIs occurred in isolation.ConclusionsDuring multiple anatomic region CT imagng for adult blunt trauma evaluation, the yield for CSI in >1 region is low. In low-risk populations, selective CT imaging of anatomic regions (instead of reflexive head-to-pelvis CT imaging) may be more appropriate.



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Health Care Usage and Suicide Risk Screening within 1 Year of Suicide Death

Publication date: December 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Amy R. Stuck, Michael P. Wilson, Christen E. Chalmers, Jonathan Lucas, Andrew Sarkin, Kyle Choi, Kimberly Center
BackgroundResearch indicates patients often seek medical care within 1 year of suicide. Health care encounters are a crucial opportunity for health professionals to identify patients at highest risk and provide preventative services.ObjectiveStudy aims were to determine the characteristics of persons seeking health care within 12 months of suicide death and evaluate suicide risk screening (SRS) frequency in the emergency department (ED) vs. clinic settings.MethodsMedical examiner and hospital data of patients who died by suicide from 2007 to 2013 were evaluated. Descriptive analyses included demographics and frequency of ED vs. clinic visits. We also compared SRS before and after implementation of The Joint Commission's recommendation to assess suicide risk.ResultsThe 224 deceased patients were primarily single white males (mean age 67 years). Mental health issues, substance abuse, and prior suicide attempts were present alone or in combination in 74%. Visits were primarily behavioral health or substance abuse problems in the ED, and medical issues in the clinic. After implementation of universal SRS in the ED, screening increased from 39% to 92%. Among patients screened in the ED, 73% (37 of 51) screened negative for suicide risk.ConclusionsUniversal SRS increased the number of people screened in the ED. However, negative SRS may not equate to reduced risk for future suicide within 1 year. Future studies might investigate targeted screening of individuals with known suicide risk factors, as well as alternatives to patient self-report of intent to self-harm for patients with mental health or substance abuse problems.



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The effect of time restricted visual sensory input on asymmetry of ground reaction force components in female children

Publication date: Available online 29 November 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Mozhgan Faraji Aylar, AmirAli Jafarnezhadgero, Fatemeh Salari Esker, Robert Barber, D.G.E. Robertson
The association between visual sensory and the asymmetry index of sit-to-stand ground reaction force characteristics is not fully understood. Therefore, the purpose of this study was to investigate asymmetry index of sit-to-stand ground reaction forces, their times–to-peak, vertical loading rate, impulses, and free moment in blind and sighted children. 15 female children with congenital blindness and 30 healthy girls with no visual impairments volunteered to participate in this study. The girls with congenital blindness were placed in one group and the girls with no visual impairments were randomly divided into two groups of 15. The two condition groups consisted of, one eyes open and the other, eyes closed. The participants in the eyes closed group were asked to close their eyes for 20 min before the test, whereas those in the eyes open group kept their eyes open. Kinematic and kinetic data were collected using an eight-camera motion analysis system synchronized with two force plates embedded in the floor. A MANOVA test was run for between-group comparisons. There were no distinctive biomechanical alternations in all axes of ground reaction forces and their times-to-peak, vertical loading rate, impulses and free moments in congenital blindness and eyes closed groups compared with the eyes open group. However, eyes closed was associated with increased total time and second phase duration of sit-to-stand performance by 69% (p = 0.008) and 62% (p = 0.008), respectively. These findings reveal that individuals who are visually restricted in the short term, do not develop stereotypical movement strategies for sit-to-stand.



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An examination of the relationship between dynamic knee joint stiffness and gait pattern of children with cerebral palsy

Publication date: Available online 29 November 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Manuela Galli, Veronica Cimolin, Claudia Condoluci, Pier Francesco Costici, Reinald Brunner
Dynamic joint stiffness represents the resistance that a joint opposes to an applied moment. Stiffness arises in conditions of joint laxity, instability and increased co-contraction and is commonly utilized as a means to stabilize the joint. The knee joint seems to be crucial for determining the walking pattern. The aim of this study was to investigate the association between the gait pattern, globally quantified by the Gait Profile Score (GPS), which indicates the 'quality' of a particular walking strategy, and knee dynamic joint stiffness (Kk) in children with diplegia. Kk is expressed by plotting the values of the knee flexion-extension moment versus the knee flexion-extension angle during weight acceptance. In this interval, the linear regression was fitted. The angular coefficient of the linear regression corresponded to the joint stiffness index. Sixty-one children with diplegia and 18 healthy individuals took part in this study. From their gait analysis data, the GPS (with its Gait Variable Scores-GVSs) and the Kk were calculated. Data showed that GPS (p = 2.73 × 10⁻²¹) and GVSs values for the patients with diplegia were higher in comparison to healthy controls. The Kk values for patients were not statistically different from those of controls. The correlation between Kk and GPS did not show the presence of any significant relationship (r = −0.04; p > 0.05). Thus, the functional limitation in diplegic children does not seems to be strictly related to Kk.



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The Clinicopathological Study of Benign Lesions of Vocal Cords

Abstract

Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. The common benign lesions of vocal cord are singer's nodule, polyps, papilloma, polypoidal degeneration and cysts. The aim of this study was to analyze the demographics such as age, sex, occupation, symptomatology, site of involvement. An objective evaluation of voice handicap was done pre and postoperatively using VHI-10 scale to see improvement in patient's symptoms. In this prospective study, a total of 50 cases were selected with benign lesions in regional hospital of India. The pre and post operative assessment for voice handicap was assessed by VHI-10. Chi square test (SPSS 20.0 version) used to analyze result; value of p < 0.05 was taken significant. In this study of 50 patients, the benign lesions were most common in 20–29 age group. Male (70%) outnumbered females (30%). Most common was Vocal polyp (56%), followed by nodule (32%), cyst (10%) and papilloma (2%) respectively. All patients showed improvement after phonosurgery and postoperative speech therapy, being assessed by VHI-10 scale. The benign lesions of vocal cords produces symptoms which can vary from hoarseness to stridor, affect social functioning, work performance. Speech therapy following microlaryngeal surgery forms an essential part of treatment, to avoid recurrence. VHI-10 scale as found to be a useful and convenient tool in measuring patient voice handicap and to see improvement after surgery.

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Peak Nasal Inspiratory Flow as an Objective Measure

This study assesses the utility of peak nasal inspiratory flow as an objective diagnostic and outcome measure for functional septorhinoplasty in combination with the Nasal Obstruction Symptom Evaluation scale.

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Length of Stay for Free Tissue Transfer to Head and Neck Defects

This database review evaluates patient and surgical factors associated with length of stay and reoperation following surgical procedures for malignant neoplasm of the head and neck involving microvascular free tissue transfer reconstruction.

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Association of Hearing Loss and Otologic Outcomes With Fibrous Dysplasia

This study characterizes audiologic and otologic manifestations in a cohort of individuals with fibrous dysplasia and/or McCune-Albright syndrome and investigated potential mechanisms of hearing loss.

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Association of Lymph Node Density With Survival in Papillary Thyroid Cancer

This cohort study assesses the association of lymph node density—the ratio of the number of positive lymph nodes to the total number of nodes excised—with survival in patients with papillary thyroid cancer.

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Asymptomatic Septal Mass

A woman in her 40s presented with a 2-month history of an enlarging asymptomatic anterior septal mass; she denied a history of localized trauma, and examination revealed an 8-mm pink-red, soft fleshy growth posterior to the membranous septum near the nostril apex. What is your diagnosis?

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Indoor air quality of everyday use spaces dedicated to specific purposes—a review

Abstract

According to literature data, some of the main factors which significantly affect the quality of the indoor environment in residential households or apartments are human activities such as cooking, smoking, cleaning, and indoor exercising. The paper presents a literature overview related to air quality in everyday use spaces dedicated to specific purposes which are integral parts of residential buildings, such as kitchens, basements, and individual garages. Some aspects of air quality in large-scale car parks, as a specific type of indoor environment, are also discussed. All those areas are characterized by relatively short time use. On the other hand, high and very high concentration levels of xenobiotics can be observed, resulting in higher exposure risk. The main compounds or group of chemical compounds are presented and discussed. The main factors influencing the type and amount of chemical pollutants present in the air of such areas are indicated.

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Water quality in simulated eutrophic shallow lakes in the presence of periphyton under different flow conditions

Abstract

Although the effects of periphyton on water quality and its relationship with flow conditions have been studied by researchers, our understanding about their combined action in eutrophic shallow lakes is poor. In this research, four aquatic model ecosystems with different water circulation rates and hydraulic conditions were constructed to investigate the effect of periphyton and flow condition on water quality. The concentrations of NH₄⁺, TP, and chlorophyll–a and flow conditions were determined. The results show that, as a result of the rising nutrient level at the early stage and the decline in the lower limit, the presence of periphyton can make the ecosystem adaptable to a wider range of nutrients concentration. In terms of the flow condition, the circulation rate and hydraulic condition are influential factors for aquatic ecosystem. Higher circulation rate in the ecosystem, on one hand, facilitates the metabolism by accelerating nutrient cycling which is beneficial to water quality; on the other hand, high circulation rate leads to the nutrient lower limit rising which is harmful to water quality improvement. At low velocities, slight differences in hydraulic conditions, vertical velocity gradient and turbulence intensity gradient could affect the quantity of phytoplankton. Our study suggests that, considering environmental effect of periphyton, flow conditions and their combined action is essential for water quality improvement and ecological restoration in eutrophic shallow lakes.

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The Clinicopathological Study of Benign Lesions of Vocal Cords

Abstract

Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. The common benign lesions of vocal cord are singer's nodule, polyps, papilloma, polypoidal degeneration and cysts. The aim of this study was to analyze the demographics such as age, sex, occupation, symptomatology, site of involvement. An objective evaluation of voice handicap was done pre and postoperatively using VHI-10 scale to see improvement in patient's symptoms. In this prospective study, a total of 50 cases were selected with benign lesions in regional hospital of India. The pre and post operative assessment for voice handicap was assessed by VHI-10. Chi square test (SPSS 20.0 version) used to analyze result; value of p < 0.05 was taken significant. In this study of 50 patients, the benign lesions were most common in 20–29 age group. Male (70%) outnumbered females (30%). Most common was Vocal polyp (56%), followed by nodule (32%), cyst (10%) and papilloma (2%) respectively. All patients showed improvement after phonosurgery and postoperative speech therapy, being assessed by VHI-10 scale. The benign lesions of vocal cords produces symptoms which can vary from hoarseness to stridor, affect social functioning, work performance. Speech therapy following microlaryngeal surgery forms an essential part of treatment, to avoid recurrence. VHI-10 scale as found to be a useful and convenient tool in measuring patient voice handicap and to see improvement after surgery.

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Trends in Cancer Survival by Health Insurance Status in California From 1997 to 2014

This population-based study of data from the California Cancer Registry examines trends in cancer survival by health insurance status from January 1997 to December 2014.

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Lymph Node Burden and Mortality Risk in Hypopharynx and Larynx Cancer

Staging systems for squamous cell carcinoma of the head and neck (SCCHN) vary by anatomic subsite. Nodal classifications across subsites are similar and are based on the size, number, and laterality of positive regional lymph nodes (LNs). In clinical practice, it is commonly held that contralateral nodal metastases are a poor prognosticator, and the same logic is generally applied to cases with large positive nodes. The American Joint Committee on Cancer's AJCC Staging Manual, 8th edition, to be implemented in 2018, continues using the traditional nodal characteristics and adds extranodal extension as an important feature.

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Metastatic Lymph Node Burden in Hypopharyngeal and Laryngeal Cancer

This analysis examines the association between metastatic lymph node burden and overall survival in patients with laryngohypopharyngeal cancers.

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Efficacy of Medicaid for Patients With Cancer in California

Medicaid in California (MediCal) is neither safe nor effective. If MediCal were a drug, a responsible regulator should consider pulling it from the market. In their Original Investigation published in this issue of JAMA Oncology, Ellis and colleagues analyze survival from California's population-based California Cancer Registry and demonstrate that MediCal is a disaster for Californians. MediCal and the related Children's Health Insurance Program provide health care coverage insurance to nearly 12.3 million of California's 39.3 million residents.

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Zoledronic Acid Dosing in Patients With Metastatic Breast Cancer—Reply

In Reply We appreciate the thoughtful review and statistical analysis of our results by Hasegawa and colleagues. The primary end point of efficacy in OPTIMIZE-2 (measured by the skeletal-related event [SRE]) was met using a predefined noninferiority margin of 10%, albeit the upper limit of the 1-sided 97.5% CI (9.8%) was very close to the noninferiority boundary of 10%. This predefined noninferiority margin was chosen on the basis of SRE data from the first year of treatment due to the absence of SRE data from the second year of treatment when the trial was designed, and it went through several levels of review and endorsement by clinical experts. From a practical perspective, as the predefined margins are narrowed, the sample size required increases, thus making the completion of the trial difficult. In addition, it is practically impossible to demonstrate complete equivalence, and all noninferiority trials have the possibility of demonstrating some reduction in efficacy between the 2 groups. The predefined margins, determined at the start of the trial, indicate that these differences were considered acceptable. For the purpose of interpretation of trial results from OPTIMIZE-2, we urge readers to use their own judgment to decide whether the potential differences in efficacy are acceptable or not.

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Zoledronic Acid Dosing in Patients With Metastatic Breast Cancer

To the Editor Hortobagyi et al conducted a noninferiority study for zoledronic acid dosing every 12 weeks (12W), comparing it with its counterpart of dosing every 4 weeks (4W) in women with breast cancer metastatic to bone. The primary end point was whether the patient had at least 1 debilitating skeletal-related event (SRE) by 12 months. The SREs occurred in 44 patients (22.0%) in the 4W zoledronic acid group and 47 patients (23.2%) in the 12W zoledronic acid group. The treatment difference (12W minus 4W) is 1.2%, with the upper bound of the 1-sided 97.5% confidence interval (CI) being 9.8%, barely within the prespecified noninferiority margin of 10%. That is, potentially, 12W zoledronic acid can be 9.8% worse than 4W zoledronic acid with respect to the SRE rate. Using such a large observed noninferiority margin to claim that 12W is as good as 4W is debatable.

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Cancer of the Head of the Pancreas: Early Surgery or Preoperative Biliary Drainage?

Conditions:   Pancreatic Cancer;   Biliary Stasis
Intervention:   Device: Tannenbaum Fr 10 stent or WallFlex stent
Sponsor:   Helsinki University Central Hospital
Recruiting

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Pembrolizumab Plus Epacadostat, Pembrolizumab Monotherapy, and the EXTREME Regimen in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-669/ECHO-304)

Conditions:   Recurrent Head and Neck Squamous Cell Carcinoma;   Metastatic Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: Pembrolizumab;   Drug: Epacadostat;   Drug: Cetuximab;   Drug: Cisplatin;   Drug: Carboplatin;   Drug: 5-Fluorouracil
Sponsors:   Incyte Corporation;   Merck Sharp & Dohme Corp.
Not yet recruiting

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Radiotherapy vs Neck Dissection for Clinical T1/2N0 Supraglottic Cancer

Condition:   Supraglottic Cancer
Interventions:   Radiation: Radiatherapy;   Procedure: Selective neck dissection
Sponsors:   Tianjin Medical University Cancer Institute and Hospital;   Tianjin Medical University General Hospital;   Tianjin Medical University Second Hospital
Not yet recruiting

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Cancer of the Head of the Pancreas: Early Surgery or Preoperative Biliary Drainage?

Conditions:   Pancreatic Cancer;   Biliary Stasis
Intervention:   Device: Tannenbaum Fr 10 stent or WallFlex stent
Sponsor:   Helsinki University Central Hospital
Recruiting

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Pembrolizumab Plus Epacadostat, Pembrolizumab Monotherapy, and the EXTREME Regimen in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-669/ECHO-304)

Conditions:   Recurrent Head and Neck Squamous Cell Carcinoma;   Metastatic Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: Pembrolizumab;   Drug: Epacadostat;   Drug: Cetuximab;   Drug: Cisplatin;   Drug: Carboplatin;   Drug: 5-Fluorouracil
Sponsors:   Incyte Corporation;   Merck Sharp & Dohme Corp.
Not yet recruiting

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Radiotherapy vs Neck Dissection for Clinical T1/2N0 Supraglottic Cancer

Condition:   Supraglottic Cancer
Interventions:   Radiation: Radiatherapy;   Procedure: Selective neck dissection
Sponsors:   Tianjin Medical University Cancer Institute and Hospital;   Tianjin Medical University General Hospital;   Tianjin Medical University Second Hospital
Not yet recruiting

http://ift.tt/2ArqV23

Scientific abstracts from the 2017 ACOMS and CAOMS Joint Scientific Conference and Exhibition

Publication date: Available online 21 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): ACOMS




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Predictors of obturator functioning and satisfaction in turkish maxillectomy patients using an obturator prosthesis

Publication date: Available online 22 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Meltem Ozdemir-Karatas, Ali Balik, Gulumser Evlioglu, Ömer Uysal, Kadriye Peker
ObjectiveTo determine the socio-demographic, behavioral and clinical factors affecting obturator function and satisfaction using the Obturator Functioning Scale (OFS) in maxillectomy patients rehabilitated with obturator prostheses.Material and methodsStudy sample consisted 41 maxillectomy patients. The OFS was translated and adapted into Turkish for assessing obturator functioning and patient satisfaction. Data were collected from patients' medical records and self-completed questionnaires, including the Turkish version of the OFS, socio-demographic and behavioral characteristics. Descriptive statistics, Mann Whitney U test, Spearman's correlation coefficient, and backward stepwise multiple linear regression were used for data analysis.ResultsInternal consistency (Cronbach's Alpha = 0.85) and test-retest reliability (Intraclass correlation coefficient = 0.86) were acceptable for the OFS. The most frequently reported problem was "difficulty in chewing". Bivariate analysis revealed significant differences in total OFS scores in terms of surgery type, defect size, and education level, except for the other clinical and socio-demographic characteristics and behavioral factors. Education level and surgery type were found to be the most important predictors of patient satisfaction and obturator functioning.ConclusionThe Turkish version of the OFS might be a useful tool for clinicans to identify the patients who are at risk for poor obturator functioning and satisfaction as well as their unmet needs.



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Prevalence of temporomandibular disorders discovered incidentally during routine dental examination using the research diagnostic criteria for temporomandibular disorders

Publication date: Available online 21 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Wael M. Talaat, Omar I. Adel, Saad Al Bayatti
ObjectivesTo assess the prevalence of temporomandibular disorders (TMD) discovered incidentally during routine dental examination, identify disease patterns, and evaluate patients' attitude toward accepting treatment.Study designA total of 3009 subjects were examined at the University Dental Hospital Sharjah. Research Diagnostic Criteria for TMD (RDC/TMD) Axes I and II were used for assessment. Subjects with acute/serious dysfunction symptoms underwent cone-beam computed tomography (CBCT) examination. MRI was used to confirm the diagnosis of disc displacement.ResultsNon-self-reported TMD prevalence was 10.8% (n=325). Among TMD patients, the disorders were diagnosed more in women (65.85%) (p<0.05), and between the ages of 25 and 45 (65.54%) (p<0.05). Axis I assessment revealed disc displacement with reduction (group IIa) was the most common (40.92%). Axis II chronic pain grade (CPG) showed 32.62% of TMD patients experienced chronic pain, whereas 66.77% had mild disability. Interest to pursue treatment was indicated by 92.31% of patients. CBCT and MRI assessment changed the primary diagnosis in 26.08% and 18.47% of cases, respectively.ConclusionsTMD screening during routine dental examination led to the diagnosis of non-self-reported TMD, most commonly related to disc displacement with reduction. Radiographic assessment was important to confirm TMD diagnosis. Patients diagnosed with TMD during dental screening expressed interest in pursuing treatment.



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Khat and synthetic cathinones: emerging drugs of abuse with dental implications

Publication date: Available online 22 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Worku Abebe
The rising global availability of the stimulant and euphoric substances, khat and synthetic cathinones, has become a cause for concern in many countries, including the US. Both substances are illegal in US, although this has not deterred the use. Besides central nervous system effects, these drugs also cause sympathomimetic and oro-dental adverse effects, similar to those of amphetamine. While synthetic cathinones are more stronger than khat in most cases, the latter additionally contains tannins, which have astringent effects on tissues components, including in the oral cavity. Recognizing the use prevalence and reported oro-dental adverse effects of khat and synthetic cathinones, dental practitioners should be more familiar with these substances in order to optimally treat and educate their patients abusing them. This paper reviews the pharmacology and adverse effects of khat and synthetic cathinones, along with the extent of their use in US, with particular emphasis on dental implications.



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Reply to the letter to the editor

Publication date: Available online 21 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jesca Silva, Priscila Andrade, Bruno Sotto-Maior, Neuza Assis, Karina Lopes Devito




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Acknowledgement of reviewers 2017

Publication date: Available online 20 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology





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DNA methylation polymerase chain reaction (PCR) array of apoptosis-related genes in pleomorphic adenomas of the salivary glands

Publication date: December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 6
Author(s): Núbia Braga Pereira, Ana Carolina de Melo do Carmo, Kelma Campos, Sara Ferreira dos Santos Costa, Marina Gonçalves Diniz, Ricardo Santiago Gomez, Carolina Cavalieri Gomes
ObjectiveThe aim of this study was to evaluate the DNA methylation profile in 22 apoptosis-related genes in pleomorphic adenomas (PAs) of the salivary glands, in comparison with normal salivary glands (NSGs), and to address the differences in methylation patterns between smaller and larger tumors. Additionally, we investigated if the hypermethylation of differentially methylated genes between NSGs and PAs impacted the messenger RNA (mRNA) transcription.DesignTwenty-three fresh PA samples and 12 NSG samples were included. The PA samples were divided into 2 groups: PAs with clinical size larger than 2 cm (n = 12) and PAs with clinical size 2 cm or smaller (n = 11). DNA methylation at the promoter region of a panel of 22 genes involved in apoptosis was profiled by using a human apoptosis DNA methylation polymerase chain reaction array, and the transcriptional levels of genes showing differential methylation profiles between PAs and NSGs were assessed.ResultsTNFRSF25 and BCL2 L11 were highly methylated in PAs, in comparison with NSGs, irrespective of tumor size. However, no difference could be observed in the mRNA transcription between PAs and NSGs.ConclusionsHypermethylation of the proapoptotic genes BCL2 L11 and TNFRSF25 is observed in PA. However, this phenomenon did not impact mRNA transcription.



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Multifocal occurrence of intraoral isolated MS in a patient without leukemic presentation: a case report and literature review

Publication date: Available online 22 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Yanxin Shen, Lei Zhao, Yafei Wu, Ping Huang
Myeloid sarcoma (MS), also referred to as chloroma or granulocytic sarcoma, is a rare extramedullary malignant tumor composed of immature myeloid cells. MS usually occurs with acute myelocytic leukemia (AML), myeloproliferative neoplasm, or myelodysplastic syndrome, or as a recurrence of AML; however, MS may occasionally present isolated, without current or previous peripheral blood or bone marrow involvement. The oral and maxillofacial MS, especially isolated, is extremely rare, and the clinical manifestations are diverse and usually non-specific. Here we report a rare case of isolated nonleukemic MS involving the gingivae, mucosa of the left maxillary edentulate region and the adjacent hard palate. The pertinent literature was also reviewed to provide additional clarification on the clinicopathologic characteristics, differential diagnosis, treatment regimens and prognosis of oral and maxillofacial isolated MS.



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Evaluation of clinical and radiographic indices as predictors of osteoporotic fractures: a 10-year longitudinal study

Publication date: Available online 21 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Grethe Jonasson, Valter Sundh, Magnus Hakeberg, Margareta Ahlqwist, Lauren Lissner, Dominique Hange
ObjectivesTo evaluate two radiographic and three clinical indices as predictors of future osteoporotic fractures.Study designIn a prospective, longitudinal study with a 10-year fracture follow-up, the two radiographic indices, mandibular cortical erosion (normal, mild/moderate erosion, and severe erosion of the inferior cortex) and cortex thickness, were assessed using panoramic radiographs of 411 women, aged 62-78 years. The clinical indices were the fracture assessment tool, FRAX^(R), the osteoporosis index of risk, OSIRIS, and the osteoporosis self-assessment tool, OST.ResultsThe relative risks (RR) for future fracture were significant for FRAX^(R)>15%, 4.1 (95% CI: 2.4-7.2), and for severely eroded cortices, 1.7 (95% CI: 1.1-2.8). Cortical thickness <3mm, OSIRIS, and OST were not significant fracture predictors (RR 1.1, 1.4, and 1.5 respectively). For the five tested fracture predictors, Fisher's exact test gave the following p-values for differences between fractured and non-fractured groups: FRAX^{( R)} <0.001, cortical erosion 0.023, OST 0.078, OSIRIS 0.206, and cortical thickness 0.678. The area under the curve (AUC) was 0.69 for FRAX^(R)>15%, 0.58 for cortical erosion, and 0.52 for cortical thickness. Adding OSIRIS and OST did not change AUC significantly.ConclusionFRAX^(R) and severely eroded cortices predicted fracture but cortical thickness, OSIRIS, and OST did not.



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It is not about lip retraction

Publication date: Available online 21 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Sze Lok Lau




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Accuracy of biomarkers obtained from cone beam computed tomography in assessing the internal trabecular structure of the mandibular condyle

Publication date: December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 6
Author(s): Fouad H. Ebrahim, Antonio C.O. Ruellas, Beatriz Paniagua, Erika Benavides, Karl Jepsen, Larry Wolford, Joao Roberto Goncalves, Lucia H.S. Cevidanes
ObjectiveThe aim of this study was to validate the ability of cone beam computed tomography (CBCT) to measure condylar internal trabecular bone structure and bone texture parameters accurately.Study DesignSixteen resected condyles of individuals undergoing temporomandibular joint replacement were collected and used as samples. These condyles were then radiographically imaged by using clinically oriented dental CBCT and research oriented micro–computed tomography (micro-CT). The CBCT scans were then compared with the gold standard micro-CT scans in terms of 21 bone imaging parameters. Descriptive histologic investigation of the specimens was also performed.ResultsSignificant correlations were found for several imaging parameters between the CBCT and micro-CT images, including trabecular thickness (r = 0.92), trabecular separation (r = 0.78), bone volume (r = 0.90), bone surface area (r = 0.79), and degree of anisotropy measurements (r = 0.77).ConclusionsMeasurements of trabecular thickness, trabecular separation, bone volume, bone surface area, and degree of anisotropy obtained from high-resolution dental CBCT images may be suitable bone imaging biomarkers that can be utilized clinically and in future research.



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Reply to the Letter to the Editor: Comments in relation to the CPC case entitled:

Publication date: Available online 20 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Natália Batista Daroit, Bruna Jalfim Maraschin, Vinícius Coelho Carrard, Pantelis Varvaki Rados, Fernanda Visioli




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A symptomatic swelling of the upper lip

Publication date: Available online 17 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ana Carolina Uchoa Vasconcelos, Adriano Mota Loyola, Ana Paula Neutzling Gomes, Vera Cavalcanti de Araújo, Sandra Beatriz Chaves Tarquínio, Felipe Martins Silveira, Maria Cássia Ferreira de Aguiar




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Announcement

Publication date: December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 6





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Anticoagulants are dental friendly

Publication date: Available online 16 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Michael J. Wahl, Craig S. Miller, Nelson L. Rhodus, Peer Kämmerer, Atanaska Dinkova, Rajesh V. Lalla, Branislav V. Bajkin




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A genome-wide DNA methylation analysis in peripheral blood from patients identifies risk loci associated with Graves’ orbitopathy

Abstract

Objective

Graves' orbitopathy (GO) is an inflammatory orbital disease of autoimmune origin with the potential to cause severe functional and psychosocial effects. The pathogenesis has not been fully elucidated. We investigated whether DNA methylation was associated with GO incidence in Chinese patients.

Materials and methods

Six GO patients and six age-matched controls were recruited, and genome-wide DNA methylation patterns were analyzed in their peripheral blood. t tests were performed to determine differential methylated sites in genomic regions and the univariable logistic regression analyses was performed to evaluate their risk with GO incidence. Cluster analysis and principal component analysis (PCA) were performed to determine the effects of the extracted differentially methylated sites.

Results

One hundred and forty-eight differentially methylated sites were identified, including CD14 (fold change = 4.31, p = 0.005), IL17RE (fold change = 2.128, p = 0.005), and DRD4 (fold change = 0.25, p = 0.004), and were supported by cluster and PCA analyses. Univariable logistic regression analyses showed that the methylation patterns at 12 loci were associated with GO incidence. The relative risk per 1% decrease in methylation at ZCCHC6 and GLI3 was 0.15 (95% CI 0.03–0.91; p = 0.039) and 0.65 (95% CI 0.42–0.98; p = 0.042), respectively. Pearson correlation analyses demonstrated that methylation levels at IL17RE were positively associated with Clinical Activity Score (CAS) (r = 0.967, p < 0.05).

Conclusions

Our results demonstrate that differential methylation levels at analyzed sites (genes) may be risk markers of GO. DNA methylation analysis could provide new insights into understanding the disease and provide new treatment strategies for GO in Chinese patients.

http://ift.tt/2zDdAAc

NAFLD/NASH in patients with type 2 diabetes and related treatment options

Abstract

Type 2 diabetes may reduce life expectancy and patients' quality of life due to its micro- and macro-vascular complications and to the higher risk of several types of cancer. An emerging important factor is represented by the hepatic involvement; it is recognized that excessive hepatic fat accumulation represents a typical feature of diabetic patients and that it also plays an important pathogenic role. It is now evident that non-alcoholic fatty liver disease (NAFLD), generally perceived as a benign condition, may have on the contrary an important deleterious impact for diabetic patients increasing the risk to develop cardiovascular complications but also serious hepatic diseases, in particular non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Lifestyle intervention, bariatric surgery and several drug therapies have now accumulated evidence of efficacy in treating NASH. On the other hand, their durability and safety in the long-term is yet to be proven and their use may be sometimes associated with side effects or higher risk of adverse events limiting the regular administration or contraindicating it. Professional health care providers, building awareness about the importance of these hepatic complications, should put more efforts in primary prevention using a behavioral therapy needing a multidisciplinary approach, in secondary prevention applying on a regular basis in the clinical setting available predictive algorithms to identify the patients at higher cardiovascular and hepatologic risk, and in tertiary prevention treating, when not contraindicated, the diabetic patients preferentially with drugs with proven benefit on NAFLD/NASH.

http://ift.tt/2nerhUe

Impact assessment of projected climate change on diffuse phosphorous loss in Xin’anjiang catchment, China

Abstract

Diffuse nutrient loss is a serious threat to water security and has severely deteriorated water quality throughout the world. Xin'anjiang catchment, as a main drinking water source for Hangzhou City, has been a national concern for water environment protection with payment for watershed services construction. Detection of diffuse phosphorous (DP) pollution dynamics under climate change is significant for sustainable water quality management. In this study, the impact of projected climate change on DP load was analyzed using SWAT to simulate the future changes of diffuse components (carriers: water discharge and sediment; nutrient: DP) at both station and sub-catchment scales under three climate change scenarios (RCP2.6, RCP4.5, and RCP8.5). Results showed that wetting and warming years were expected with increasing tendencies of both precipitation and temperature in the two future periods (2020s: 2021~2030, 2030s: 2031~2040) except in the 2020s in the RCP2.6 scenario, and the annual average increasing ratios of precipitation and temperature reached − 1.79~3.79% and 0.48~1.27 °C, respectively, comparing with those in the baseline (2000s: 2001~2010). Climate change evidently altered annual and monthly average water discharge and sediment load, while it has a remarkable impact on the timing and monthly value of DP load at station scale. DP load tended to increase in the non-flood season at Yuliang due to strengthened nutrient flushing from rice land into rivers with increasing precipitation and enhanced phosphorous cycle in soil layers with increasing temperature, while it tended to decrease in the flood season at Yuliang and in most months at Tunxi due to restricted phosphorous reaction with reduced dissolved oxygen content and enhanced dilution effect. Spatial variability existed in the changes of sediment load and DP load at sub-catchment scale due to climate change. DP load tended to decrease in most sub-catchments and was the most remarkable in the RCP8.5 scenario (2020s, − 9.00~2.63%; 2030s, − 11.16~7.89%), followed by RCP2.6 (2020s, − 10.00~2.90%; 2030s, − 9.00~6.63%) and RCP4.5 (2020s, − 6.81~5.49%, 2030s, − 10.00~9.09%) scenarios. Decreasing of DP load mainly aggregated in the western and eastern mountainous regions, while it tended to increase in the northern and middle regions. This study was expected to provide insights into diffuse nutrient loss control and management in Xin'anjiang catchment, and scientific references for the implementation of water environmental protection in China.

http://ift.tt/2kcr42I